Organization
FAIRVIEW PHARMACY SERVICES LLC
Active
Other names
FAIRVIEW LAKES PHARMACY WYOMING
Organization subpart
No
Provider details
NPI number
Authorized official
SAMEER BADLANI (CHAIRMAN OF THE BOARD)
(612) 617-3799
Entity
Organization
Contact information
Practice address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 982-7500
(651) 982-7504
Mailing address
NW 7429, PO BOX 1450, MINNEAPOLIS, MN 55485-7429
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
262536
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790717783
—
MN
01
—
2047842
PK
—
05
—
236142600
—
MN
Enumeration date
07/07/2006
Last updated
03/12/2025
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